The government’s statement that there are 11,200 more doctors and 2,100 more nurses on the wards since 2010 (Hospitals offer doctors £95 an hour as staffing crisis grows, 15 April) is not the experience of those of us in frontline NHS work. Last year 30% of foundation doctors (those who have finished medical school and are at the point of choosing the specialty to train in up to consultant level) chose not to apply for specialist training straight away and went off to do something else. Many will come back, but many won’t. This year the reluctance to carry on rose to 50%. It appears Jeremy Hunt has been the best recruiter for the Australian and New Zealand medical services. People who chose to train as doctors are clearly reviewing their options.
Why this has happened is plain to see. An underfunded NHS, a new contract imposed on the junior medical workforce, increased tuition fees at medical schools and subsequent debt have, together with Brexit, produced a perfect storm of unhappiness and uncertainty about the future in the NHS and in the country. The fallout from Brexit is that there are 10,000 NHS doctors who qualified in the European Economic Area – and a recent British Medical Association survey found that 42% plan to leave.
The UK already has fewer doctors per person than other leading European economies at 2.8 per 1,000 people: Germany has 4.1, France 3.3 and Italy 4.2. If you think that waiting two weeks for a GP appointment or more than four hours in A&E is unacceptable at the moment, then just wait for 2019 when we finally do Brexit. There will be no extra £350m a week for the NHS as promised on the side of a bus.
Dr Michael Maier
• The junior doctor contract reforms had their roots in providing a “seven-day service” – a reasonable idea given many hospitals run a skeleton staff over the weekend. A smaller hospital with a staff of 10 or 15 junior doctors for 150 inpatients would cut down to three or four at the weekend. I dreaded the weekend ward cover: patients and nurses clamouring for attention and emergencies requiring you to be in several places simultaneously.
This laudable idea has been mangled into a catastrophe. Alterations of weekend pay rates and caps on maximum number of days worked means staffing now suffers globally and continuity of patient care becomes a casualty of doctors being shoved from one post to another. The gaps reduce quality of life, meaning jobs are unfilled and the situation worsens.
Can you blame someone wanting high rates to cover a shift with massive responsibility, no breaks and the risk of GMC suspension and lawsuits if they slip up in an impossible workload? The NHS, in trying to iron out gaps and make staffing cheaper, is paying out more in danger money to those brave or foolish enough to take it.
Dr William Watson
• Katie Johnston is right (How to start a social care revolution in seven easy steps, 10 April). If we want value for money in the NHS, to continue spending more and more on hospitals – the most expensive component of the service – to the relative exclusion of other, more widely used parts, is doomed to failure. Hospitals need help, but a key way to do that is to invest elsewhere. That requires a change in strategic approach far greater than the initiatives currently being pursued by NHS England.
It means using digital technology to allow people to be more involved in accessing and managing services without leaving home. It means investment in expanding general practice and other primary care facilities. And it means building intermediate care and social care facilities as a matter of urgency, not least to reduce demand on hospitals and to allow the timely discharge of patients. Currently, our acute hospitals are receptacles into which we tip ever more medical and social care. And then we wonder that hospitals cannot cope.
These changes would reduce demand on hospitals, provide better value for money and offer a greatly improved service for us all, whether or not we need hospital care. Most patients do not.
• Perhaps Jeremy Hunt would like to explain why he picked a fight with junior doctors over the imposition of a new contract, ostensibly to allow safer staffing at weekends, when hospitals are now increasingly unable to fill rota gaps without resorting to imploring doctors to provide additional cover at exorbitant pay rates.
Labour has gained plaudits for its proposal on provision of free school meals. Is it not time for a comparable initiative on health? The party should cease its internecine warfare, remind the electorate that the last Labour government increased NHS spending five times faster than the coalition and set up a commission to gain general agreement on a bold plan for a permanent solution to the NHS funding crisis.
Dr Anthony Isaacs
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